Provider Demographics
NPI:1619006947
Name:INDIVIDUALIZED THERAPEUTIC REHABILIATION, LLC
Entity Type:Organization
Organization Name:INDIVIDUALIZED THERAPEUTIC REHABILIATION, LLC
Other - Org Name:ITR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-770-7060
Mailing Address - Street 1:4815 SAINT ELMO AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-7061
Mailing Address - Country:US
Mailing Address - Phone:301-770-7060
Mailing Address - Fax:703-991-5369
Practice Address - Street 1:4815 SAINT ELMO AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-7061
Practice Address - Country:US
Practice Address - Phone:301-770-7060
Practice Address - Fax:703-991-5369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18949174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty